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Biomedical subjects

J M Dubernard

Publications and source records attributed to J M Dubernard.

At least 163 records · Page 9Linked to original sources
PubMed1989

Kidney-graft survival in simultaneous kidney-pancreas transplantation.

Patient and kidney survival rates were compared between 69 diabetic patients undergoing simultaneous kidney-pancreas transplantation (group 1) and 723 nondiabetic patients undergoing kidney transplantation (group 2). The patients were treated with different immunosuppressive regimens over the years: steroids plus antilymphocyte globulin (ALG) plus azathioprine (Aza); cyclosporin A (CsA) plus ALG; steroids plus ALG plus Aza, replacing Aza 1 mo posttransplantation; or low doses of steroids plus CsA plus Aza. One-year kidney survival rates with the different regimens were 50, 42, 54, and 76%, respectively, in group 1 and 71, 74, 78, and 84%, respectively, in group 2. Patient survival was 60, 57, 71, and 86%, respectively, in group 1 and 93, 95, 94, and 96%, respectively, in group 2. Differences between the two groups were statistically significant for the first three protocols but not for the one used in this study. In group 1, 38 patients (55%) had a functioning kidney graft, whereas 15 (21%) lost their kidney to rejection. Between these two patient categories, there was no significant difference in age, sex, duration of diabetes, time on dialysis, blood transfusion number, HLA immunization, or HLA matching. Thus, since 1984, kidney-graft survival has not been inferior in diabetic patients. This improvement is mainly due to a decreased mortality related to better patient preparation and improvement in immunosuppression.

Graft Survival↗
PubMed1989

Islet cell autoimmunity in type I diabetic patients after HLA-mismatched pancreas transplantation.

The aim of this study was to investigate a possible reenhancement of islet cell autoimmunity in type I (insulin-dependent) diabetic patients who received HLA-mismatched pancreas transplants from cadaveric donors and who underwent generalized immunosuppression. Circulating islet cell antibodies (ICA) and complement-fixing ICAs (CF-ICAs) have been tested at 1, 2, 3, 6, and 12 mo and at least once a year posttransplantation in 23 recipients of 25 transplants (22 simultaneous with kidney, 2 retransplants, 1 isolated; 23 segmental neoprene injected, 2 whole with enteric drainage). Patients were aged 35.3 +/- 1.9 yr with a duration of diabetes of 20.6 +/- 1.1 yr. Immunosuppression consisted of double or triple association of azathioprine, cyclosporin, and prednisone with or without temporary antilymphocyte globulins. The number of HLA-A and HLA-B compatibilities was none in 8 patients, one in 12 patients, two in 4 patients, and three in 1 patient. The mean follow-up was 4.0 +/- 0.4 yr/patient (range 0.4-7.2). ICAs were positive pretransplantation in 2 of 25 patients and reappeared 1-42 mo posttransplantation in another 7. In 6 patients, CF-ICAs were also positive. In 7 of 9 ICA+ patients the pancreas transplant failed; in 1 patient this occurred 4 mo before ICA reappearance, and in 6 patients it occurred 2-35 mo after the first detection of ICAs. Pancreas-transplant failure was significantly associated with the positivity for ICAs (P less than .05) and particularly for CF-ICAs (P less than .005). ICA positivity was transitory in 4 patients (2-27 mo) and persistent in the remaining 5 (up to 61 mo).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Epstein-Barr virus associated lymphoproliferative diseases (B cell lymphoma) after transplantation.

We report 12 cases of lymphomas which occurred among 1670 patients with kidney or combined renal and pancreatic transplantation. Group 1 comprised nine patients presenting with the diffuse form of the disease where immunoblasts or mature plasma cells massively infiltrated all organs. The first symptom was a viral syndrome, associated with a restriction of heterogeneity of immunoglobulins; oligoclonal to monoclonal peaks of immunoglobulins appeared about 50 days after transplantation. All patients received antilymphocyte globulins (ALG), and seven were treated with cyclosporin. EBV infection could be demonstrated in almost all patients; three EBV lymphoblastoid cell lines were established, their HLA phenotype being the same as the recipient of the graft. All patients finally died with renal and hepatic failure. Group 2 comprises three patients who presented solid B cell tumours of tonsils, lungs, and spleen at onset, extending to liver, kidney graft, lymph nodes, and brain. All received cyclosporin; two patients were treated with ALG, and one with OKT3. Immunoglobulins were polyclonal, oligoclonal, or decreased. Cell surface immunoglobulins were monoclonal on two tumours. EBV-DNA was positive within two tumours. Two patients presented EBV and CMV primary infection. CD4+T lymphocytes subsets were diminished at onset, and increased after cessation of immunosuppressive therapy. One patient died because of brain involvement; the two others are alive, one with perfect graft function. Therapy consisted of stopping immunosuppressive treatment, Acyclovir, and in two patients of group 2, monoclonal antibodies to pan-B and EBV receptor antigens.

Acyclovir↗
PubMed1989

Renal transplantation at the University of Lyon.

Over the last 23 years, progress in renal transplantation has dramatically decreased mortality and transplant failures, especially during the first years following the transplant. Further improvement in immunosuppression or in induction of specific unresponsiveness should, in the future, limit the incidence of late failures. More experience in transplantation has led to reduced frequency and severity of most complications. This has resulted in acceptance of patients with risk factors such as old age or infancy, poor vascular status, hyperimmunization, or requirement for several transplants (kidney + pancreas, kidney + heart, kidney + liver, etc.). Optimum organ procurement facilities will be required to meet the increased demand for kidney transplants. It is hoped that this need will be stabilized when late transplant failures will become infrequent, thus decreasing the requirements for retransplantation.

Blood Transfusion↗
PubMed1988

[Vesico-ureteral-renal reflux in the adult. Preliminary results of endoscopic treatment].

Vesico-ureteric reflux in adult patient may now be treated endoscopically by injecting teflon under the ureteral orifices. Twenty-six ureteral units were treated by this technique in 18 patients. Correction of the reflux was obtained in 22 units (85 p. 100); the technique was ineffective in 4 units (15 p. 100). No complication was observed in this series; in particular, there was no stenosis of the intramural ureter. These encouraging preliminary results have to be confirmed on a long-term basis in large series of patients.

Endoscopy↗
PubMed1988

Post-transplant renal artery stenosis: a cause of anuria. Report of 2 cases corrected by revascularization.

We report 2 cases of severe hypertension and acute onset of anuria after renal transplantation in which angiography revealed renal artery stenosis. After renal artery reconstructive surgery renal function returned to normal and the hypertension improved. A high index of suspicion is needed to make the diagnosis. Only by heightened awareness of this important entity will patients with post-transplantation anuria secondary to renal artery stenosis be identified. Such patients may benefit from renal artery revascularization to reverse this type of renal failure.

Adult↗
PubMed1988

Cyclosporine plasma levels six hours after oral administration. A useful tool for monitoring therapy.

Clinical evolution and cyclosporine (CsA) monitoring of 65 transplanted patients (55 kidneys, and 10 kidneys and pancreases) treated with CsA were analyzed retrospectively (45 patients) and prospectively (34 patients). Our results showed the following: (1) nephrotoxicity is not uncommon even with low trough plasma levels of CsA; (2) the T6 value of a CsA pharmacokinetic plasma curve (6 hr after oral drug administration) is a valid expression of a full pharmacokinetic study; (3) when T6 was used prospectively as a monitoring tool and dose adjustments made disregarding concomitant serum creatinine levels, the latter decreased when CsA dose adjustments were made to correct toxic (greater than 350 ng/ml) or subtherapeutic (less than 100 ng/ml) T6, P less than 0.01. At present, serum creatinine for all our patients is 180.2 +/- 8 mumol/L, and no patient has needed to be switched to conventional treatment. The validity of trough plasma levels in patients under CsA oral administration once or twice a day seems questionable, and T6 proved to be more useful. Thus nephrotoxicity and CsA undertreatment may be avoided. This new monitoring tool (T6) will allow the utilization of lower doses of CsA and thus contribute to improved long-term graft function.

Administration, Oral↗
PubMed1988

Treatment of upper ureteral stones.

From September 1984 to March 1986, 70 patients with upper ureteral stones were treated in our institution. 43 patients underwent endoscopic procedures including retrograde ureterorenoscopy, antegrade ureterorenoscopy and percutaneous surgery. A second group of 27 patients was treated by extracorporeal shock wave lithotripsy (ESWL). The overall success rate was 74.5 and 85% for the endoscopic and the ESWL groups, respectively. Obstruction and dilatation of the renal collecting system seemed to play a major role in the failure of either endoscopic or ESWL treatment.

Adult↗
PubMed1988

[Treatment of lithiasis in horse-shoe kidney].

Between september 1985 and april 1987 the authors treated 16 patients with 27 calculi in horse-shoe kidneys. 14 patients were treated by extra-corporeal lithotrity with two failures from the outset because of impossibility of positioning the lithiasis at the second site of the ellipsoid. In the other twelve cases and 3 months after treatment there were four complete successes (no residual calculi) and eight partial successes with, in seven cases, residual calculi less than 4 mm in diameter and, in one case, a residual calculus of more than 10 mm. Of 4 percutaneous nephrolithotomies, including two from the outset, there were no post-operative complications and, only in one case, residual fragments in the inferior calyx. The authors then analyzed the special features and difficulties inherent to the unusual topography of the renal cavities of horse-shoe kidneys. Such topography leads to modifications which are described by the authors both in the technique of extra-corporeal lithotrity as well as in that of percutaneous nephrolithotomy. The study ends with an analysis of the respective indications of the two methods of extra-corporeal or endo-urological treatment of lithiasis affecting horse-shoe kidneys.

Adult↗
PubMed1987

Evaluation of bladder cancer with a miniature high frequency transurethral ultrasonography probe.

A miniature high frequency 10 MHz transurethral ultrasonography probe has been developed which is adaptable to any standard 17 F cystoscope sheath. High frequency contributed to a definite improvement in image resolution but did not allow distinct visualisation of different bladder wall layers. An 80% correlation between ultrasonographic and pathological staging was established after evaluation of 50 consecutive patients with newly diagnosed bladder tumours. Ta/T1 tumours tended to be overstaged with ultrasound. In some patients, the response to conservative treatment (external beam radiation therapy) of deeply infiltrating tumours could be assessed with the miniature probe on an out-patient basis.

Cystoscopy↗